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Neuroimaging outcomes in suspected papilledema
Theresia Knoche1, Nehir Guelsoy2, Charlotte Pietrock2
1Department of Neurology, Charité - Universitätsmedizin Berlin - Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. theresia.knoche@charite.de.
Scientific Reports
|May 26, 2026
Summary
Papilledema, often caused by elevated intracranial pressure, frequently indicates serious underlying conditions. Timely neuroimaging is crucial for diagnosis, as clinical features alone are unreliable predictors of secondary intracranial causes.
Area of Science:
- Neurology
- Radiology
- Ophthalmology
Background:
- Papilledema, a sign of elevated intracranial pressure, can signal life-threatening conditions like intracranial mass lesions or cerebral sino-venous thrombosis.
- Accurate and timely diagnosis is critical for managing patients with suspected papilledema.
Purpose of the Study:
- To evaluate neuroimaging outcomes and identify clinical predictors in adults presenting with suspected papilledema.
- To determine the diagnostic yield and number needed to scan (NNS) for CT and MRI in suspected papilledema cases.
Main Methods:
- A bicentric retrospective cohort study of 225 adult patients presenting with suspected papilledema between 2009 and 2022.
- Analysis of diagnostic outcomes, clinical features, visual acuity, and neurological deficits.
- Calculation of diagnostic yield and NNS for CT and MRI, with univariable logistic regression for predictor identification.
Main Results:
- Papilledema was confirmed in 55% of patients, with 35.5% having secondary intracranial causes.
- CT and MRI identified secondary pathology in 13.3% (NNS 7.5) and 16.7% (NNS 6) of patients, respectively.
- Clinical features like diplopia and nausea/vomiting were associated with secondary causes but lacked consistent presence.
Conclusions:
- Secondary intracranial pathology is a common finding in suspected papilledema.
- Clinical features have limited discriminatory value for identifying secondary causes.
- Prompt neuroimaging is essential for the diagnostic evaluation of suspected papilledema.
